Medical Benefits

Blue Care offers multiple medical deductible options, a limited out-of-pocket and the highest level of benefits when services are provided by a Network Provider. Physician benefits include a primary care and specialist copay.

Medical Deductible (Per Member Per Calendar Year)
Benefit Period:	Calendar Year	Lifetime Benefits:	Unlimited

Medical Deductible Options
$250	$500	$1,000	$1,500	$2,000	$2,500	$5,000	$7,500

 

Physician Services – Office Visit
Primary Care**	Specialist	Non-Network Provider
100% after $15 Copay	100% after $25 Copay	50%

** Also applies to office visits with an allied primary care professional (i.e. nurse practitioner, physician assistant).

Copay does not apply to any other services rendered in the office. Other services (i.e. surgery, diagnostic services, etc.) rendered in the physician's office are subject to the Benefit amounts.

Medical Out-of-Pocket Maximum for a Network Provider
Out-of-Pocket	Non-Emergency Copay	Network Provider Benefits	Non-Network Provider Benefits
$5,000	$350	80%	50%

All services are subject to the Network Provider and Non-Network Provider Benefits. Some benefits are not covered when rendered by a Non-Network Provider.

For more detailed information about Blue Care benefits click here.

Out-of-State Non-Emergency Services

Non-emergency services provided by an out-of-state provider require prior approval for coverage under the Blue Care benefit plan. If a Network Provider thinks non-emergency (elective) services are needed from a provider located outside of Mississippi, that Network Provider will need to pre-certify those services for network benefits to be provided. Our Health and Wellness Team can assist the Network Provider in determining if the services needed can be provided in Mississippi.

Our Network Providers can help you get the most out of your health and wellness benefits. You can see the many healthcare providers in Network Provider Search.

This Blue Care Medical Benefit summary is designed for the purpose of presenting general information about the Blue Care Health and Wellness Benefit Plan and is not intended as a guarantee of benefits. All services referenced in this Health and Wellness Benefit Plan are subject to Medical Policy and Medical Necessity review to determine if the services are covered. This is not a Summary Plan Description and in the event of a conflict between this document and the actual Health and Wellness Benefit Plan, the terms of the Health and Wellness Benefit Plan will prevail.

be RxSmart Prescription Drug Benefit

Our be RxSmart prescription drug benefit plan is designed to help you make the most of your healthcare dollar through the use of generics and other low-cost alternatives to many brand name drugs. We also offer enhanced drug searches and cost-savings tools through our myBlue member portal.

Prescription Drug Deductible (Per Member Per Calendar Year)
Copay Plan	Standard Deductible	$100
	Deductible Options	$250	$500	$750	$1,000	$1,500	$2,000

 

Copay by Drug Category
Category	Community PLUS Pharmacy	Non-Community PLUS Pharmacy
Category 1 Drugs*	$10 Copay	No Benefits
Category 2 Drugs	$25 Copay	No Benefits
Category 3 Drugs	$50 Copay	No Benefits
Category 4 Drugs	$100 Copay	No Benefits

* When you choose Category One drugs, you only have to pay the applicable co-pay amount. The prescription drug deductible will not apply.

For more detailed information about Blue Care benefits click here.

This Blue Care Prescription Drug Benefit summary is designed for the purpose of presenting general information about the Blue Care Health and Wellness Benefit Plan and is not intended as a guarantee of benefits. All services referenced in this Health and Wellness Benefit Plan are subject to Medical Policy and Medical Necessity review to determine if the services are covered. This is not a Summary Plan Description and in the event of a conflict between this document and the actual Health and Wellness Benefit Plan, the terms of the Health and Wellness Benefit Plan will prevail.

Blue Health Management

To keep you healthy, our Health and Wellness Team will work with your Network Provider to make sure your necessary care is provided in the most cost-effective setting, to include our Centers of Excellence. Based on your health status, you may also qualify for our Blue Health Management Program.

Our Blue Care health and wellness benefit plan is also designed to support you with lifestyle changes, such as tobacco cessation or beginning an exercise program. For information about tobacco cessation or to find a wellness center near you that will discount your membership if you are a Blue Cross & Blue Shield of Mississippi member, click on the "be healthy" link at the top of this page.

myBlue

The myBlue web portal gives members 24/7 access to everything related to their benefit plans. With myBlue, members can access claims history, prescription drug information, electronic EOBs and more. Here are additional details:

• Registration is quick, easy, secure and useful. You have access to the health benefit information you want, when you want it.
• You can view claims history for the previous 15 months, including payments, copay and deductible amounts. You can go green and stop the mailing and delivery of paper EOBs.
• You can give us important information online at any time – no need to call during business hours only. You can update your phone number or email, and you can order a new ID card on myBlue.

When you apply for Blue Care health and wellness coverage, you will also be asked questions that will be used to determine your eligibility for optional life coverage through Bluebonnet Life. Bluebonnet Life Insurance Company is an independent life insurance company that does not provide Blue Cross & Blue Shield of Mississippi products or services, and is solely responsible for the life insurance coverage referenced above.